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Annals of Surgical Oncology

, Volume 24, Issue 6, pp 1569–1578 | Cite as

Complications after Hepatectomy for Hepatocellular Carcinoma Independently Shorten Survival: A Western, Single-Center Audit

  • Alexandre Doussot
  • Chetana Lim
  • Eylon Lahat
  • Chady Salloum
  • Michael Osseis
  • Concepción Gómez Gavara
  • Eric Levesque
  • Cyrille Feray
  • Philippe Compagnon
  • Daniel AzoulayEmail author
Hepatobiliary Tumors

Abstract

Background

The impact of postoperative complications (POCs) on long-term outcomes following hepatocellular carcinoma (HCC) resection remains to be ascertained.

Methods

All consecutive HCC resected at a single center were analyzed. Patients with POCs, classified according to Clavien classification, were compared to those without in terms of demographics, pathology, management, overall survival (OS), and disease-free survival (DFS). Independent prognostic factors of POCs were identified using multivariable regression models.

Results

Among 341 patients, overall POCs rate was 34% (n = 116) and grade III–IV POCs rate was 14.4% (n = 49). POCs were an independent negative factor for OS [hazard ratio (HR) 1.40, 95% confidence interval (CI) 1.12–2.26, p = 0.009] with BCLC stage, the need for combined procedure, intraoperative transfusion, and the METAVIR score of the underlying parenchyma. Similarly, occurrence of POCs was associated independently with DFS (HR 1.59, 95% CI 1.18–2.15, p = 0.002), together with the presence of portal hypertension, BCLC stage, the need for combined procedure, intraoperative transfusion, and the presence of satellite nodules. After stratification, the negative impact of morbidity on OS and DFS reached statistical significance in the BCLC stage A subset only (p = 0.026, and p < 0.001, respectively). Open resection, intraoperative transfusion, and the existence of underlying liver injury were independent predictors of POCs.

Conclusions

POCs should be considered as a long-term prognostic factor. Careful patient selection requiring underlying liver assessment and appropriate strategy, such as mini-invasive surgery and restricted transfusion policy, might be promoted to prevent POCs.

Keywords

Overall Survival Portal Hypertension Portal Vein Embolization Laparoscopic Liver Resection Barcelona Clinic Liver Cancer 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Alexandre Doussot
    • 1
  • Chetana Lim
    • 1
  • Eylon Lahat
    • 1
  • Chady Salloum
    • 1
  • Michael Osseis
    • 1
  • Concepción Gómez Gavara
    • 1
  • Eric Levesque
    • 2
  • Cyrille Feray
    • 3
  • Philippe Compagnon
    • 1
    • 4
  • Daniel Azoulay
    • 1
    • 4
    Email author
  1. 1.Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Henri MondorAssistance Publique-Hôpitaux de Paris, AP-HPCréteilFrance
  2. 2.Department of Anesthesiology and Intensive Care, Hôpital Henri MondorAssistance Publique-Hôpitaux de Paris, AP-HPCréteilFrance
  3. 3.Department of Hepatology, Hôpital Henri MondorAssistance Publique-Hôpitaux de Paris, AP-HPCréteilFrance
  4. 4.INSERM 955CréteilFrance

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